Biochemical Injury of Burns Wounds
Local
biochemical injury begins within 1 h of the thermal insult
and lasts for up to approximately 72 h post-burn.
This
persists through the thermal biochemical reaction phase and the
biochemical inflammatory reaction phase on the time order.
At 1–2 h
postburn, there is a significant increase in capillary permeability
occurring in the injured, though still viable tissues, contiguous with
the necrosis caused by direct thermal injury.
This results in exudation
of intravascular fluid toward the wound surface and interstitial space
while tissue ischemia is occurring.
Simultaneously, the injured
but viable tissues and cells in the area of lesion develop edema due to
metabolic disorder.
At this time, the permeable capillaries release
plenty of chemical substances which not only locally aggravate the
injury itself and damage the peripheral uninjured areas, but also may
subsequently result in systemic injury.
Although it is not quite clear
what these chemical substances are, they appear to include histamine,
5-HT, hydrogen ion, kinin and bradykinin, etc. This phase
is called the
‘thermal
biochemical reaction phase’.
About
2 h later, the thermal biochemical reaction continues to affect the
viable tissues in the injured area to cause a series of inflammatory
reactions.
The initiation of such an inflammatory
pathological reaction
in the injured area may result in the full spectrum of pathological
injuries.
For instance, inflammatory reaction activates the
blood coagulation system to induce progressive thrombosis of the
microcirculation, which may cause necrosis of the injured but viable
tissues and may also result in ischemic and anoxic necrosis of the
surrounding uninjured tissues.
This process may last for 72 h postburn and is
called the ‘biochemical
inflammatory reaction phase’.
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